OBJECTIVES

Asthma is one of the most common chronic diseases in Colombia. Despite the availability of asthma controller medications, many patients are still not meeting therapeutic goals because of poor disease management. Our objective was to estimate clinical impact and cost-utility of inhaled corticosteroid therapy in patients with mild-to-moderate asthma.

METHODS

A decision-analysis model was developed to evaluate the cost-effectiveness of budesonide-formoterol (160µg/4.5µg) Maintenance And Reliever Therapy (SMART) versus salmeterol/fluticasone plus salbutamol as needed (SFC) and vs beclomethasone plus salbutamol, a short-acting beta-agonist (SABA), as a standard of care (SoC). We had a cohort of 1000 adults with mild-to-moderate persistent asthma, with 24 years old, a life expectancy of 80 years, from a third payer perspective, and clinical and economic outcomes over a one-year horizon were evaluated. Costs of medication, hospitalization and emergency room (ER) visits were included. A responder scenario analysis was conducted to determine cost-effectiveness incremental ratio (ICER) per quality-adjusted life year (QALYs) for SMART vs SFC+SABA and vs SoC.

RESULTS

Over a one-year treatment horizon, SMART allowed 6,788 QALYs more than SoC and 2,248 more than SFC+SABA. Salmeterol-formoterol was $43,893 cheaper than SFC+SABA and $5,907 more expensive than SoC. Hospitalization and ER visits costs in SMART were $35,967 cheaper than SFC+SABA and $202,417 cheaper than SoC. Budesonide-formoterol is a cost-saving strategy vs SFC+SABA and SoC in Colombia. In tornado diagram, results are more sensible to medications costs. In willingness-to-pay curves, under 1 gross domestic product in Colombia ($6,325.40), SMART strategy has 100% of probabilities to be the best option.

CONCLUSIONS

: Budesonide-formoterol is a dominant strategy vs SFC+SABA and vs SoC in adult patients with mild-to-moderate asthma in Colombia. SMART allowed more QALYs and was cheaper than SFC+SABA and SoC, this is because budesonide-formoterol has better clinical results than SFC+SABA and SOC and avoided cost because there is fewer exacerbations with SMART.